Some aspects of “Carpal Tunnel syndrome” with homoepathic mode of treatment

Carpal Tunnel syndrome is an entrapment neuropathy of wrist. It is a disorder caused by compression at wrist of median nerve supplying hand, which causes tingling, numbness.
Sex- Women are more affected than men.

Age- Usually between 30 to 60 years.

Aetiology- Most cases are idiopathic. Trauma to wrist causing fracture or sprain, pregnancy, multiple myeloma, amyloidosis, rheumatoid arthritis, acromegaly or hypothyroidism all may play a role in the development of carpal Tunnel syndrome.

Risk factors-
(1) History of affection of any family member.
(2) Certain occupations.
(3) Stress.
(4) Obesity.
(5) Smoking.
(6) Oral contraceptives.
(7) Age over 40 years.

Associated medical conditions- Carpal Tunnel syndrome is sometimes associated with pregnancy, multiple myeloma, amyloidosis, rheumatoid arthritis, acromegaly or hypothyroidism.

Pathophysiology- Pressure on the median nerve due to a swelling or anything that makes the Carpal Tunnel smaller compresses the median nerve at wrist which in turn causes tingling, numbness, weakness or pain.

Clinical Features-
(1) The first symptoms to appear are usually at night during sleep & cause nocturnal tingling & pain in the hand & sometimes forearm.
(2) It may be followed by weakness of the thenar muscles.
(3) There may be wasting of abductor pollicis brevis with sensory loss of the palm & radial three & a half fingers which are supplied by the median nerve.
(4) Tinel Test - Taping on the median nerve or on the carpal tunnel if reproduces a shock or tingling in fingers is suggestive of Carpal Tunnel syndrome & Tinel Test is said to be positive.
(5) Phalen test – Flexion of wrist causes compression of median nerve in the tunnel with the result of paresthesia in the median nerve distribution, thus reproducing the patient’s symptoms.

Investigations- The diagnosis of carpal Tunnel syndrome is based primarily on symptoms & clinical findings. X-rays may be advised which would help in detecting any fracture in the wrist that may be the cause of carpal Tunnel syndrome. MRI can also be done for visualizing injury to median nerve. However, the most important diagnostic test for confirmation of the disease is median nerve conduction study which of course has some limitations because a small percentage of patients may have negative result in spite of features suggestive of carpal Tunnel syndrome while a small percentage of asymptomatic individuals have positive results. Besides these, ultrasound imaging, electromyography may also be done.

Differential Diagnosis- Carpal Tunnel syndrome may be confused with nerve compression caused by a cervical disk herniation, thoracic outlet structures. Pain due to osteoarthritis of 1st carpal-metacarpal joint may also simulate that due to carpal Tunnel syndrome.

Treatment-
[A] General measures to be taken are-
(1) Splinting or bracing.
(2) Modification of activity.
(3) Occupational therapy.
(4) Physiotherapy.

[B] Homeopathic medicines to be used – There are a lot of homeopathic medicines which can be used in the treatment of Carpal Tunnel syndrome. Causticum, Lycopodium, Apis, Calcerea carb, Ruta Graveolens (Ruta), Rhus toxicodendron (Rhus tox), Arnica etc can be used according to the presenting clinical features. Ruta may be used when there is pain & stiffness in wrists & hands, Causticum for numbness & loss of sensation in hands, Apis for numbness of hands & tips of fingers. Arnica is usually used when there is flare-up of inflammation or new injury caused by repetitive use of fingers & wrists. Rhus tox is useful when there are stiffness & pain which get worse on initial motion but improve as movement continues. Besides these, Lycopodium may be used if tingling & numbness is confined to the radial three & a half fingers with or without wrist swelling. Calcerea carb may also be used for tingling & numbness & swelling in wrist & the radial three & half fingers. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual. Lower potency is to be used at the beginning. If response is not satisfactory a second dose should be used. If desired effect is still not noticed, it is better to switch over to a new medicine.

Prevention-
(1) Reduction of obesity.
(2) Immediate treatment of any disease which may cause carpal Tunnel syndrome.
(3) Regular breaks from repeated hand movements to allow hands & wrists to take a rest.

Prognosis- Carpal Tunnel syndrome is usually not grave. With treatment pain subsides & there is usually no lasting damage to hand or wrist. When the condition occurs in pregnancy due to fluid retention it usually requires no treatment as it is self-limiting.

In short, carpal tunnel syndrome is manifested by tingling, numbness, weakness or pain in hand due to compression of the median nerve at wrist & is to be treated by Rhus tox, Ruta, Arnica, Causticum etc.

But in every case, a doctor should be consulted.

Some aspects of “Golfer’s elbow” with homoepathic mode of treatment

Also referred to as medial tennis elbow, Golfer’s elbow is a tendinopathy of the insertion of the flexors of the fingers of the hand & the pronators.
Epitrochleitis or Golfer’s elbow is very similar to lateral epicondylitis or tennis elbow but occurs on the medial side of the elbow, where the pronator teres & the flexors of the wrist & fingers originate. Tensing of these muscles by resisted wrist & finger flexion in pronation will provoke the pain.

Sex- Golfer elbow is most common in men.

Age- 20 – 50 years of age but the condition can affect anyone who repetitively stresses the wrist or the fingers.

Risk factors-
(1) Repeated or forceful movements of the fingers, wrist & forearm which causes repetitive strain on forearm flexors.
(2) Acute trauma may also play a role.

Pathophysiology- The flexor muscles of hand, wrist & forearm on excessive strain or over-use, may become irritated, inflamed & swollen. This causes pain & tenderness at the medial epicondyle of humerus. If not arrested at this point & allowed to progress, the tendon develops small tears in it at its attachment to the humerus.

Clinical Features-
(1) The most common symptom is pain & tenderness on inner side of elbow. The pain may occasionally extend along inner side of forearm. Onset of pain is usually gradual & aggravated by using the affected muscles while grasping objects or shaking hands. Tenderness is often less well localized than in tennis elbow.
(2) There may be a feeling of stiffness of elbow.
(3) Weakness of hands & wrists may also be there.
(4) Numbness or tingling sensation radiating into usaully ring & little fingers may be present.
(5) There will be pain on resisted forearm pronation with elbow extended or pain on resisted wrist flexion & these are the tests for clinical diagnosis.

Investigations- Golfer’s elbow is usually diagnosed clinically. X-ray of elbow is often done to rule out arthritis. MRI may be advocated if clinical diagnosis is difficult to be confirmed.

Differential Diagnosis- Golfer’s elbow is usually to be differentiated from Olecranon bursitis, Elbow arthritis, Carpal tunnel syndrome.

Treatment- It is the same as for tennis elbow but the treatment is even less satisfactory.
[A] General measures to be taken are-
(1) Rest.
(2) Restriction or total stoppage of activities causing pain.
(3) Elbow braces.
(4) Stretching exercises for flexor muscles which should be started after the disappearance of the symptoms of Golfer elbow. If there is any pain during or after the exercises, it should be stopped immediately.
(5) Physiotherapy.

[B] Homeopathic medicines to be used – Homeopathy may be used effectively in the treatment of Golfer elbow. If it is supposed to be due to overuse, Bryonia should be tried. Ruta Graveolens (Ruta) & Rhus toxicodendron (Rhus tox) are the medicines most commonly used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual. Besides these, if it is supposed to be due to any previous injury, Arnica can be very effectively used. On the other hand, if it is supposed to be due to overuse, Bryonia may be tried.

Prevention-
(1) Modification of activities or particular techniques that lead to the development of this overuse injury.
(2) Guidance of a coach for sporting activities may often be helpful.

Prognosis- Golfer elbow is usually a self-limited problem which is quite unlikely to cause any long-term health hazard. With athletes a change in technique often resolves the problem. Life style modification is to be considered if Golfer elbow does not resolve or if it recurs.

In short, Golfer’s elbow is manifested by pain & tenderness on the medial side of the elbow & is to be treated by Rhus tox, Ruta, Arnica etc.

But in every case, a doctor should be consulted.